The Enhanced Doctor

Chapter 1208: Chapter 1208: Dyspnea Patients Without Clear Indicators

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"Just as Director Chen is here, you should also discuss the patient’s situation with him." Liu Banxia said.

Li Hao hurriedly repeated the patient’s basic information and recent examination results.

Both he and Liu Banxia leaned towards a cardiac condition, and since Chen Xuehai is a cardiac surgeon, this consultation seemed appropriate.

"This patient’s situation is indeed somewhat complicated."

After listening, Chen Xuehai frowned and said.

"The two known prominent symptoms are difficulty breathing, even without a continuous ECG, the blood oxygen level must be low. Another concern is his platelet count, which is a bit low."

"However, this might also be due to the recent tormenting symptoms, and a count of 80 isn’t too low, as the lower limit of the normal range is 100. We should observe further."

"So, both of you are leaning towards cardiac causes, right? He’s so young, has no underlying conditions, and isn’t experiencing high fever, so it shouldn’t be endocarditis or myocarditis."

"Let’s conduct an echocardiogram, followed by tests for heart failure and myocardial infarction, and then a blood culture. This time inform the lab to expedite the process, just say it’s my request."

"Thank you, Teacher Chen."

Li Hao, having received the orders, ran back straight away.

"Should we transfer him to our department immediately or observe for now?" Chen Xuehai asked.

"Let’s observe first, as we’re currently not certain. Even if it is due to cardiac issues and doesn’t require surgery, it should go to cardiology to avoid troubling the patient with unnecessary transfers." Liu Banxia said.

"I once saw a university student with myocarditis. However, her temperature was indeed high, which doesn’t match this patient’s presentation."

"Yes, that’s why I left a small question for Li Hao, without explicitly pointing out the possibility of pulmonary embolism—let’s see if he figures it out." Chen Xuehai said.

"You’re such a troublemaker, why torture the kids like this?" Liu Banxia shook his head.

He also thought of the possibility of a pulmonary embolism, but he didn’t say it.

If Li Hao comes up with it himself, this case will be deeply engraved in his mind. If he doesn’t, I’ll give him a hint later, which will still make the memory more profound.

Upon hearing this, both Chen Xuehai and Wang Chao rolled their eyes simultaneously.

"What’s up? Did I say something wrong?" Liu Banxia asked innocently.

"If it’s about causing trouble for them, if you’re second, no one dares claim first." Wang Chao said.

"Hahaha, not really, I’m still working on it." Liu Banxia laughed and said.

"But they’ve already gotten familiar with my ways, so it’s not that easy anymore. The opponents are evolving, we need to think even harder now."

"Gentlemen, are you eating now or later?" At this moment, Qi Wentai came over.

"You guys go ahead, Li Hao’s recently admitted patient is quite complex, we’re waiting for some results." Liu Banxia said.

"Alright, we’ll head to eat first." Qi Wentai nodded.

"By the way, do you think the likelihood of the patient having a pulmonary embolism is high?" Liu Banxia continued to ask.

"If it’s early-stage pulmonary embolism, the symptoms might not be very pronounced, right? If the echocardiogram doesn’t show anything either, should we opt for an enhanced CT?"

"If there’s nothing wrong with the heart, then we’ll have to consider this aspect." Chen Xuehai said.

"Why are you curious about this? A general surgeon always thinking about patients in other departments, you’re quite amusing. When are you crossing over to our cardiac surgery?"

Faced with Chen Xuehai’s tease, Liu Banxia helplessly shook his head, "I can’t manage that, I don’t even know how to handle my current work. At least this year is out of the question, maybe next year."

"This year, the most I might do is start some pediatric surgeries. Lately, I’ve been studying this, although it’s stressful, it really helps the children."

"It’s strange, ever since I had two little ones, I adore everyone else’s children immensely. So, I’ve set a goal for myself this year to delve into pediatric surgery."

"That’s an overflow of fatherly love, and Chen Hongyang will surely be delighted—he’s always short-handed, now he has a strong addition." Chen Xuehai said.

The three continued chatting here, pausing the discussion about the previous patient for now.

Since the indications point towards the heart and lungs, they’ll need to wait for the results to have a clearer direction for discussion.

In fact, although Liu Banxia considered the possibility of a pulmonary embolism, he was also inclined towards a cardiac issue.

Even if the ECG appears normal, wasn’t that female patient’s ECG normal too? Only during a recurrence did the ECG show any waveforms.

With the priority given by Chen Xuehai for this expedited test, it was truly expedited. The results came back quickly, although Li Hao’s facial expression wasn’t very positive.

"There wasn’t anything noted on the cardiac ultrasound, and we also scanned the lungs. The blood test results show normal cardiac enzymes and troponin, but one abnormal result, the BNP level is a bit high—is it heart failure?" Li Hao asked.

"Give me the form, let me take a look." Chen Xuehai said with a frown.

Liu Banxia’s expression also became serious. If it’s heart failure, the patient’s situation could be very severe.

Although it’s called brain natriuretic peptide, its main source is the heart, and the brain natriuretic peptide indicator plays a significant role in suggesting heart failure.

When there is cardiac dysfunction, it greatly activates the natriuretic peptide system, increasing ventricular load and leading to the release of brain natriuretic peptide.

It’s similar to the significance of creatine kinase and troponin for myocardial infarction; both can be considered definitive indicators.

"This is indeed quite high, right now we can’t solely suspect myocardial infarction, let’s go see the patient." After looking over, Chen Xuehai said.

Li Hao quickly led the way ahead.

This was also Liu Banxia and his first time seeing the patient, who should have been a very energetic young man, but now looked somewhat listless. Wearing an oxygen mask, he seemed to be exerting effort to breathe.

"Your current condition is quite serious; our inclination is that your symptoms are caused by heart dysfunction," after finishing the auscultation, Chen Xuehai said.

"So we need to give you an enhanced CT scan to check the condition of your cardiovascular and pulmonary vessels and perform further exclusion, but enhanced CT is an invasive examination."

Next to him, Li Hao quickly gave the patient a simple explanation about the enhanced CT scan.

"Do it, otherwise, it’s too difficult to breathe," the patient said wearily.

"Besides finding it hard to breathe and feeling chest tightness, do you have any chest pain?" Chen Xuehai asked further.

The patient shook his head, "No, it’s just a bit difficult to breathe. I always feel like I’m not getting enough air."

"Li Hao, sign the form and go directly for the enhanced CT. I’ll come with you." Chen Xuehai said.

Li Hao nodded and hurried to prepare the confirmation form for the enhanced CT.

"Doctor, do I have a heart disease?" the patient asked.

Chen Xuehai thought for a moment and nodded slightly, "This is just our judgment inclination, we are currently also considering the possibility of a pulmonary embolism."

"Therefore, we need to perform an enhanced CT on your chest. If there is a blockage in any vessel, we can see it directly."

"If the blood flow is slowed down due to blockage and insufficient in volume, it can also cause symptoms of low blood oxygen. If that’s the case, it’s quite simple; we can just give you some anticoagulants."

"Doctor, can’t you give them to me now?" the patient asked.

"No, not now. The use of anticoagulants must be cautious. Especially since your platelet count is somewhat low now, using them recklessly could be life-threatening," Chen Xuehai said.

"What cold medicines have you been taking at home? Have you been taking multiple cold medicines at once? How’s your diet?"

"I’ve just been taking Contac, feeling lousy and unable to eat, just forcing myself to swallow a bite," the patient said.

"Alright, don’t worry for now, we’ll do a sensitivity test right away, and if there’s no problem, we’ll get a clear result after the examination," Chen Xuehai said.

Liu Banxia frowned slightly, while now having some suspicion of a pulmonary embolism, he still felt something was not right.

Because if it truly was a pulmonary embolism, given the patient’s current respiratory condition, surely other symptoms would present. Even with such a high-flow oxygen mask, he is still exerting so much effort to breathe.

However, when it comes to the presentation of symptoms, nothing is certain, so it’s better to check the enhanced CT results, and things will become clear.

"Director Liu, do you think it could be myocarditis? But it feels somewhat off, without symptoms of high fever and chest pain." Wang Chao said after Chen Xuehai and the others took the patient away.

"This patient’s condition is really quite uncertain. Initially, I thought it was a myocardial infarction, but then ruled it out. Now, I feel both the possibilities of a pulmonary embolism and myocarditis are somewhat low, what do you think?" Liu Banxia asked with a wry smile.

"I’m even more confused, this patient’s symptom presentation feels somewhat strange, like something’s off somewhere," Wang Chao said.

"Ah, it’s precisely because there are no clear indicators that it feels strange," Liu Banxia sighed.

Ding! Task released: Patient with unclear symptoms of respiratory difficulty

Open-task: The patient proactively seeks medical attention, complaining of a cold, now presenting as unexplained respiratory difficulty, requires further diagnosis to determine the cause. Task reward: Issued based on diagnosis results.

Even though the system issued a task, Liu Banxia felt not the slightest bit of joy.

Because with the patient’s current situation, there is potential for symptoms to change drastically at any moment.

He almost wanted to ask the patient to contact his family just now, but worried that saying so might cause significant emotional changes in the patient, provoking symptom development.

Normal people experience emotional fluctuations when nervous, not to mention this patient.

He has a hunch that the enhanced CT might not yield any results.

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